Trends of Human Plague, Madagascar, 1998–2016

Abstract

Madagascar is more seriously affected by plague, a zoonosis caused by Yersinia pestis, than any other country. The Plague National Control Program was established in 1993 and includes human surveillance. During 1998–2016, a total of 13,234 suspected cases were recorded, mainly from the central highlands; 27% were confirmed cases, and 17% were presumptive cases. Patients with bubonic plague (median age 13 years) represented 93% of confirmed and presumptive cases, and patients with pneumonic plague (median age 29 years) represented 7%. Deaths were associated with delay of consultation, pneumonic form, contact with other cases, occurrence after 2009, and not reporting dead rats. A seasonal pattern was observed with recrudescence during September–March. Annual cases peaked in 2004 and decreased to the lowest incidence in 2016. This overall reduction occurred primarily for suspected cases and might be caused by improved adherence to case criteria during widespread implementation of the F1 rapid diagnostic test in 2002.

Field assessment of insecticide dusting and bait station treatment impact against rodent flea and house flea species in the Madagascar plague context

“…Madagascar has become the country with the highest plague burden [4]. Between 1998 and 2016, 250 to 1500 suspected cases were reported annually by the Malagasy Central Laboratory for Plague, with 18% case-fatality rates for confirmed and presumptive case-patients (1,057/5,819) [5]. The bubonic plague is the most encountered form (about 80%), however, secondary pneumonic plague can lead to overwhelming urban epidemic, such as reported in the capital in 2017 [6,7].…”

“…Traditional outdoor granaries are infrequently used due to thief problems. Crops and food are stored in the bedroom, which promotes contact between humans, rodents and their fleas [5,8]. Two flea species have been reported as confirmed vectors.…”

Human plague: An old scourge that needs new answers

“…The rapid diagnostic test (RDT) as point of care (POC) strategy was implemented in Madagascar in 2002 in primary care facilities based in the “endemic districts” together with information provided to community health workers. This RDT has been widely used and improved the specificity of diagnosis, resulting in a drop in the number of suspected cases of bubonic plague [ 64 ]. The RDT is based on monoclonal antibodies against the F1 capsular antigen of Y .…”

MAPt: A Rapid Antibiotic Susceptibility Testing for Bacteria in Environmental Samples as a Means for Bioterror Preparedness

“…Moreover, it was reported that Y. pestis can survive for at least 24 days in contaminated soil under natural conditions ( Eisen et al, 2008 ), hence creating a potentially natural-born contaminated area in case of the death of a sporadically infected animal. Plague is present in different parts of the world; recent outbreaks were reported in Uganda ( Respicio-Kingry et al, 2016 ), China ( Shi et al, 2018 ), Democratic Republic of Congo ( Abedi et al, 2018 ), and Madagascar ( Andrianaivoarimanana et al, 2019 ).…”